Background: There is no consensus regarding which surgical technique is most beneficial for pathology of the second metatarsophalangeal joint. We report the use of polyvinyl alcohol hydrogel synthetic cartilage implant hemiarthroplasty for pathology of the second metatarsal head that has failed nonoperative treatment and present 5 cases with a minimum 15 months of follow-up.
Methods: The technique for synthetic cartilage hemiarthroplasty of the second metatarsal head is described. The postoperative protocol included weightbearing as tolerated for 2 weeks and moderate limitations in activities of daily living to respect wound healing, followed by physiotherapy for range of motion exercises. Charts for patients who underwent this procedure between 2015 and 2017 were retrospectively reviewed. Outcome measures collected postoperatively included a pain visual analog scale, Short-Form 36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) current level of function percentages.
Results: At 15 to 38 months of follow-up, patients reported little to no pain and good range of motion, with no complications. Mean outcome measure scores were 89 for FAAM ADL, 75 for FAAM Sports, 44.4 for SF-36 PCS, and 52.1 for SF-36 MCS.
Conclusion: This preliminary study of synthetic cartilage hemiarthroplasty for treatment of joint-destructive conditions of the second metatarsal head demonstrated good outcomes and no complications in 5 cases at a mean 25 months of follow-up. Large prospective cohort studies are needed to prove the efficacy and safety of this new surgical technique for the treatment of pathology of the second metatarsal head.
Level of evidence: Level IV, retrospective case series.
Keywords: Freiberg’s infraction; hemiarthroplasty; lesser toes; metatarsal head; polyvinyl alcohol hydrogel; synthetic cartilage implant.